Purpose Of Review: The inflatable penile prosthesis (IPP) was introduced in 1973. Since that time, the fundamental design of the IPP has not changed, but numerous improvements to the device, surgery, and peri-operative management have resulted in a modern IPP with excellent reliability, infection control, safety profile, and user experience.

Recent Findings: We describe important modifications to the IPP and review available data assessing the impact of these changes. Read More

Authors:

Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.

Our purpose was to determine if key pinch strength is predictive of patient preference for a single IPP model among three currently available models (Coloplast™ Titan, Coloplast™ Titan Touch, and the Boston Scientific AMS 700™). We prospectively recruited men without penile prostheses over 65 years old from our urology clinic. Demographic and medical history were recorded. Read More

Authors:

Objective: To determine the impact of concurrent inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) implantation on perioperative complications and long-term device survival, among men with postprostatectomy erectile dysfunction and urinary incontinence.

Methods: We identified men older than 65 treated with radical prostatectomy in the Surveillance, Epidemiology, and End Results Medicare database between 2002 and 2016. IPP or AUS placement was determined by current procedural terminology (CPT) code, with dual implantation (DI) defined as IPP and AUS placement on the same date. Read More

Aim: To evaluate the safety and efficacy of a multi-incisional technique with penile prosthesis implantation with multiple corporeal incisions and collagen grafting for the surgical management of complex cases of PD with ED and severe penile shortening.

Methods: From February 2015-May 2018, 43 consecutive patients with complex PD were treated using this technique. Read More

Authors:

Penile shunting is the standard of care in management of ischemic priapism refractory (IPR) to non-surgical interventions. Due to high rates of impotence, corporal fibrosis, and loss of penile length, recent literature suggests these patients benefit from immediate penile prosthesis (PP) placement. An IRB-exempt anonymous electronic survey of the 2168 members of the International Society for Sexual Medicine (ISSM) was conducted. Read More

Authors:

Purpose Of Review: The purpose of this review is to critically analyze and summarize recent studies in the area of penile prosthesis surgery outcomes with a focus on infection prevention in high-risk patients.

Recent Findings: Reduction of surgical time in complex prosthesis surgery may reduce infection risk. Concomitant implant surgery is not associated with increased infection risk. Read More

Background: The precise pathophysiology of venous erectile dysfunction (VED) was still unclear. Dynamic infusion cavernosometry and cavernosography (DICC) was the gold standard approach for the diagnoses of VED. However, a standard operative procedure of DICC was needed and it was unclear whether DICC could show promise in accurate assessment and treatment of VED. Read More

Penile prosthesis implantation for treatment of medical refractory erectile dysfunction remains the gold standard. However, some men have additional pathology present such as Peyronie's Disease, penile shortening, penoscrotal webbing, buried penis or other penoscrotal anatomical abnormalities that may be addressed at the time of prosthesis implantation. Although several techniques are described, there remains a lack of data regarding the outcomes. Read More

Authors:

The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Proximal corporal deformities may account for failed inflatable penile prosthesis (IPP) surgery. No contemporary series has focused solely on describing the natural history and management of isolated proximal corporal deformities in patients after IPP surgery. The aim of the current report is to present the clinical courses and surgical management with outcomes of proximal corporal deformities in the context of prior IPP implantation surgery. Read More

Purpose Of Review: Inflatable penile prosthesis (IPP) is a treatment for erectile dysfunction. IPPs have undergone improvements; however, post-surgical infections still occur. Furthermore, the type of pathogens infecting the implants has changed recently from Gram-positive to Gram-negative bacteria and fungi due to advances in antibiotic dips targeting the skin flora. Read More

Authors:

Purpose Of Review: The use of penile implant for the treatment of both erectile dysfunction and Peyronie's disease has changed little in the last 40 years, primarily limited to modeling and plaque incision. In the current review, I explore the history of Peyronie's treatment at the time of penile prosthesis placement and explore new surgical options that help resolve several of the issues that were not treated with the traditional approaches.

Recent Findings: Advancements have been made in the area of graft material, lengthening procedures, and transcorporal techniques. Read More

Recent Findings: IPP complications are rare, and reports are limited to retrospective studies. However, recent multi-institutional studies and use of national databases have provided further insight into risk factors for complications. Read More

Purpose Of Review: After radical cystoprostatectomy, patients often develop erectile dysfunction refractory to first- and second-line treatments. In this review, we summarize and analyze the literature describing the technical considerations and outcomes of penile implant surgery in bladder cancer patients with history of radical cystectomy and urinary diversion.

Recent Findings: Penile prosthesis surgery in patients after radical cystectomy and urinary diversion has been infrequently described in the literature. Read More

Recent Findings: Innovations in penile prosthesis design have facilitated the development of various alternative approaches for reservoir placement. Avoiding the space of Retzius is particularly appealing in patients with a history of pelvic surgery and/or radiation. Read More

Authors:

Department of Urology, New York Presbyterian Hospital/ Columbia University Medical Center, New York, NY, USA.

Introduction: Although diabetes mellitus (DM) is often discussed as a risk factor for inflatable penile prosthesis (IPP) infection, the link between DM diagnosis and IPP infection remains controversial. High-quality population-based data linking DM to an increased risk of IPP infection have not been published.

Aim: To evaluate the association of DM with IPP infection in a large public New York state database. Read More

Purpose: Despite a variety of free flaps that have been described for creation of the neophallus in gender affirmation surgery, none present an ideal solution. We evaluated our patients and outcomes after gender affirmation phalloplasty using musculocutaneous latissimus dorsi free flap.

Methods: Between January 2007 and May 2017, 129 female transsexuals, aged 20-53 years (mean 24 years) underwent total phalloplasty using latissimus dorsi free flap. Read More

Authors:

Department of Urology, University of Virginia School of Medicine, Charlottesville, VA 22908-0422, USA.

Placement of inflatable penile prosthesis is a procedure frequently performed for medication-refractory erectile dysfunction. Device implantation is not without risks, and as the frequency of device implantation increases, so do associated complications. The aim of this work is to review the most frequent operative complications associated with implantation of inflatable penile prostheses, and to review the best approaches to prevent these most common complications. Read More

Materials And Methods: Using an institutional prosthetic database, we identified 39 patients who underwent radical cystectomy and NB and subsequent implantation of both prosthetic devices from 2003 to 2017. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection, mechanical failure, revision surgery, and functional outcomes were examined and compared to an appropriate matched group of patients (n = 48, non-neobladder group). Read More

Authors:

Background: The purpose of this study was to report the outcomes of patients who underwent penile implantation with AMS 700 LGX inflatable penile prosthesis (IPP) in a single center by a single surgeon.

Methods: A total of 342 patients with erectile dysfunction who underwent AMS 700 LGX IPP implantation between October 2014 and April 2016 were included in this study. All patients were evaluated using the International Index of Erectile Function questionnaire preoperatively and at 3, 6, and 12 months postoperatively. Read More

Authors:

In patients presenting with early ischemic priapism, proceeding with the conventional paradigm is recommended. In those presenting late (>48 h), penile prosthesis placement can easily be performed 2-6 wk later, with no increase in surgical difficulty or morbidity. Immediate penile prosthesis implantation should be reserved for motivated patients who understand the increased associated risks, have evidence of corporal fibrosis on imaging, and are being treated in a center of excellence. Read More

Introduction: The ZSI 475FtM is a new prosthesis that has recently been specifically designed for phalloplasty. It has several functions that have been conceived to answer the challenges of implantation after phalloplasty: a large base for pubic bone fixation, realistically shaped hard glans, and a pump shaped like a testicle.

Aim: To assess the safety, feasibility, and patient satisfaction of the ZSI 475 FtM. Read More

Despite the known nephrotoxicity of gentamicin, in 2008 the American Urological Association published guidelines recommending single high-dose weight-based gentamicin prophylaxis of 5 mg/kg for procedures involving urologic prostheses. These guidelines are based on the theoretical renal safety and improved antimicrobial activity of a single large dose of gentamicin. However, the risk of nephrotoxicity after weight-based gentamicin prophylaxis specifically in penile prosthetic surgery has never been established with evidence-based studies. Read More

Introduction: A shorter penis is a frequent complaint following penile prosthesis implantation (PPI), and a large redundant suprapubic fat pad can conceal the penis and possibly compromise patient and partner satisfaction with length.

Authors:

Infections are among the most feared and devastating complications of penile prosthesis infections, often requiring surgical exploration and explantation are prosthesis infections. While the rate of infections have decreased due to antibiotic prophylaxis, antiseptic device preparation, increased sterility in implantation techniques and device modifications, infections still occur at a rate of 1-3%. This article reviews the formation of biofilms on penile prostheses and novel, experimental methods to prevent and eradicate them. Read More

Authors:

Background: Penile prosthesis for erectile restoration remains the only surgical option for medical refractory erectile dysfunction. Many expert prosthetic surgeons recommend special care when placing a reservoir in a patient who has undergone prior radical pelvic surgery (PRPS) due to distortion of anatomy and obliteration of the dead space in the traditionally used space of Retzius.

Aim: Review all the current literature on penile prosthesis implantation in patients with prior pelvic surgery, with an emphasis on tips and tricks for reservoir placement in this unique population. Read More

Authors:

Introduction: Penile prosthesis (PP) implantation is associated with high patient satisfaction and improved sexual quality of life (SQoL). The SQoL benefits of PP implantation are generalizable across subpopulations of PP implant patients, but the literature is heterogeneous in design and largely without instruments to specifically measure SQoL changes due to PP, requiring extrapolation from less granular measures.

Aim: To provide a comprehensive review of available literature regarding SQoL with a penile prosthesis. Read More

Authors:

Department of Urology, Korea University College of Medicine, Seoul, Republic of Korea.

Despite the controversy regarding penile augmentation (PA), glans penis augmentation (GPA) is used in penile reconstructive surgery in selected patients with small glans penis. Since 2003, injectable hyaluronic acid (HA) gel has been used for GPA. The attractiveness of HA gel fillers and interest in this technique have led to the use of other fillers for GPA, particularly irreversible fillers that improve the longevity of HA gels. Read More

Objective: To investigate if there is a correlation between penile size measured preoperatively and erect penis after penile implant surgery (PI). A common cause of patient dissatisfaction after PI is caused by patients complaining that surgery has shortened the penis. It has been suggested that stretched penile length preoperatively is almost the same after surgery when the prosthesis is in erect status. Read More

Authors:

University of Texas Health Science Center, McGovern Medical School at Houston, Texas.

Purpose: Alternative or ectopic reservoir placement has recently gained popularity among prosthetic surgeons to avoid injury to pelvic structures during inflatable penile prosthesis implantation. However, the true incidence of complications associated with these new techniques remains under studied. We performed a 5-year multicenter, retrospective study with the aim of evaluating complications related to alternative reservoir placement. Read More

Many patients complain of shortened length following penile prosthesis implantation. Dorsal phalloplasty (DP) can accompany prosthesis placement to mitigate this complaint by resulting in more visible penis outside the plane of the patient's body. DP is done through the same incision. Read More

Introduction: Erectile dysfunction (ED) is one of the most prevalent male sexual disorders worldwide. When conservative treatment is unsuccessful, contraindicated or causes unacceptable side effects penile prosthesis implantation is a definitive option for the management of ED. Although considered a third-line therapy, it achieves the highest satisfaction rates as compared with non-surgical treatment. Read More

Authors:

Numerous treatments have been proposed for Peyronie's disease (PD). As the evidence base has expanded, the field of operative and non-operative options for patients has narrowed. Collagenase clostridium hystolyticum (CCH) injection now comprises the medical option, and surgical possibilities entail penile plication, plaque incision/excision and grafting, and prosthesis implantation. Read More

Introduction: The sliding technique (ST), commonly done with a subcoronal circumcising incision with penile degloving, has been used to restore penile size in patients with severe Peyronie's disease (PD) and erectile dysfunction, but with a potential risk of ischemic injury to the glans penis.

Aim: To provide detailed surgical techniques regarding the nondegloving ventral incision and report our initial experience with this approach to perform the ST and penile prosthesis placement in patients with severe PD.

Methods: This was a retrospective review of patient outcomes after penile prosthesis placement with penoplasty for severe PD and erectile dysfunction from January 2015 to December 2017. Read More

Introduction: Phosphodiesterase type 5 inhibitors (PDE5i) are first-line therapy for most men with erectile dysfunction (ED). If ineffective, vacuum erection devices, intracavernous injections, and penile prosthesis implantation are suitable as second- or third-line therapies. However, very few patients select these therapies. Read More

Purpose: Post-hospital syndrome is an acquired transient period of health vulnerability following inpatient admission. We assessed the impact of a preoperative hospitalization on outcomes following penile prosthesis surgery and sought to optimize surgical timing after inpatient admission.

Materials And Methods: We used the Healthcare Cost and Utilization Project State Inpatient Databases and State Ambulatory Surgery Database for California from 2007 to 2011 and for Florida from 2009 to 2014. Read More

Background: Because sick and injured children from war and crisis areas can often only be helped to a limited extent in their countries of origin, those children with the most complex diseases often receive medical treatment in Europe.

Materials And Methods: To evaluate the postoperative outcome of reconstructive interventions in children from war and crisis areas, an evaluation of the clinic's internal database between 1997 and 2017 was carried out. The operative indication, the surgical procedure, any revisions or conversions and the overall mortality were analyzed. Read More

Authors:

Introduction: The relative infrequency of urethral injuries during penile prosthesis implantation has caused the event to be understudied relative to the morbidity and cost associated with their management.

Aim: To draw attention to both acute intraoperative and delayed urethral injuries via cylinder erosion by compiling and evaluating the available literature on their cause, diagnosis, and management.

Methods: A literature review was performed through PubMed from 1985 to 2018 regarding urethral injuries in the setting of penile prosthesis implantation. Read More

Purpose: Inflatable penile prostheses and artificial urinary sphincters are used to treat men with erectile dysfunction and stress urinary incontinence, respectively. After prostate cancer treatment men often experience erectile dysfunction and stress urinary incontinence. Dual prosthetic implantation can improve the quality of life of these men. Read More

Background: Penile prosthesis implantation into scarred corporeal bodies is one of the most challenging procedures in prosthetic urologic surgery, especially following infection and extrusion of a penile implant. Several instruments and techniques have been used for making dilatation of scarred corporeal bodies easier and safer in expert hands. Nevertheless, in some cases, implantation is not possible. Read More

1 Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy.

Objectives The objective of this study was to assess duration of efficacy, side effects and return to fertility following use of the 9.4 mg deslorelin implant (Suprelorin 12; Virbac) in cats, and test whether efficacy and duration of action are influenced by implantation site (interscapular vs periumbilical). Methods Sixteen healthy adult tom cats were checked with (1) reproductive examination, (2) gonadotropin-releasing hormone stimulation test and (3) semen collection until achievement of sterility, then with (1) and (2) only at 2, 4, 6 and 12 months, and every 6 months thereafter until treatment effect disappeared. Read More

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